PURPOSE: To measure and analyze ocular deviations between dominant and non-dominant eyes using video-oculography (VOG) in intermittent exotropia. METHODS: Fourteen subjects who were diagnosed with intermittent exotropia from July 2017 to July 2018 with age of 5 or more, visual acuity of 20/30 or better and corrected visual acuity of 20/25 or more and difference in vision of both eyes of 1 line or less on Snellen optotype were included. The subjects were asked to fixate on a black-on-white optotype at 1 m, which subtended a visual angle of 50 minutes of arc. The video files and data about ocular deviations were obtained using VOG with alternate cover test. We analyzed angles of ocular deviations in dominant and non-dominant eyes. RESULTS: Among the 14 subjects in this study, the mean age were 7.6 ± 1.7 (range 5–9 years). Seven of 14 subjects had the right eye dominance. Six of the 14 subjects were men. There was no significant difference of ocular deviations between the dominant and non-dominant eyes in VOG (p = 0.167). Additionally, there was no significant difference of the values of VOG when one eye was exodeviated or re-fixated (p = 0.244), when both eyes were deviated, and when both eyes were re-fixated (p = 0.195, 0.637). CONCLUSIONS: In this study, there was no significant difference of ocular deviations between the dominant and non-dominant eyes, between when an eye was exodeviated or fixated using VOG. Therefore, it may not be a problem even if alternate prism cover test is performed in any eye in intermittent exotropia of more than 50 prism diopter without amblyopia or refraction abnormality that could affect the uncorrected visual acuity.
Amblyopia ; Dominance, Ocular ; Exotropia ; Humans ; Male ; Strabismus ; Visual Acuity

We report a unique case of a neonate with an epidural hematoma induced by vacuum extraction. The epidural hematoma, communicating with a cephalhematoma through a linear skull fracture, disappeared after ultrasound-guided needle aspiration. The patient quickly recovered and one month later computed tomography revealed a complete resolution of the epidural hematoma.
Hematoma ; Hematoma, Epidural, Cranial* ; Humans ; Infant, Newborn* ; Needles* ; Skull Fractures ; Vacuum

We reported a case of a 55-year-old patient who presented with palpitation after swallowing. Initial surface electrocardiogram revealed ventricular preexcitation utilizing a left lateral bypass tract. The orthodromic atrioventricular reentrant tachycardia (AVRT) was induced during electrophysiologic studies. After successful ablation of the AVRT utilizing a left lateral free wall bypass tract, 2 different atrial tachycardias (ATs) were induced under isoproterenol infusion. When the patient swallowed saliva or drank water, 2 consecutive beats of atrial premature complexes (APCs) preceded another non-sustained AT repeatedly, which was coincident with the patient's symptom. The preceding APC couplet had the same activation sequence with one induced AT, and the subsequent non-sustained AT had the same activation sequence with the other induced AT, respectively. We first targeted the preceding 2 consecutive APCs at the left posterior interatrial septum. The following non-sustained AT was also eliminated following ablation of the APCs. After ablation, the patient remained free from the swallowing-induced atrial tachyarrhythmias during the one year follow-up.
Atrial Premature Complexes ; Catheter Ablation ; Deglutition ; Electrocardiography ; Follow-Up Studies ; Humans ; Isoproterenol ; Middle Aged ; Saliva ; Tachycardia* ; Water ; Wolff-Parkinson-White Syndrome*

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Ephedrine ; Fentanyl ; Humans ; Hypotension ; Knee

BACKGROUND: Clonidine has been regarded as an adequate supplementary anesthetic during epidural anesthesia and has been used with local anesthetics such as bupivacaine or lidocaine to support the effects of these anesthetics. The authors would examine whether clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia. METHODS: Thirty-two healthy patients undergoing a hip or lower limb surgery were divided into two groups. In group 1, 0.5% ropivacaine 15 ml was administered. In group 2, 0.5% ropivacaine 15 ml combined with clonidine 150 micro gram was administered. Onset, duration and maximal height of sensory block were assessed. Sedation score, blood pressure and heart rate were measured. RESULTS: Duration of sensory block of group 2 was significantly longer than that of group 1. Sedation score of group 2 was significantly higher than that of group 1. Blood pressure of group 2 was significantly lower than that of group 1 at 50 min, 70 min and 90 min after epidural injection. No significant differences were observed in onset of sensory block and heart rate between the two groups. CONCLUSIONS: The addition of clonidine to ropivacaine during epidural anesthesia prolonged duration of sensory block and produced useful sedation. It caused relatively stable hemodynamic changes. These results suggest that clonidine is an adequate supplementary anesthetic when it is used with ropivacaine during epidural anesthesia.
Anesthesia, Epidural* ; Anesthetics ; Anesthetics, Local ; Blood Pressure ; Bupivacaine ; Clonidine* ; Heart Rate ; Hemodynamics ; Hip ; Humans ; Injections, Epidural ; Lidocaine ; Lower Extremity ; Sympathetic Nervous System

BACKGROUND: Although spinal anesthesia has a lot of advantages, it has some disadvantages or undesirable effects. Hypotension and unnecessarily long neural blockade are included among them. Although using small dose local anesthetics fairly solves these problems, it is insufficient to provide reliable surgical anesthesia by itself. Therefore the authors investigated whether such an opioid as fentanyl and a small dose local anesthetic used together during spinal anesthesia can prevent hypotension and unnecessarily long neural blockade and provide reliable surgical anesthesia simultaneously. METHODS: Thirty patients undergoing knee or below knee surgery were randomized into two groups. Group 1 received bupivacaine 5 mg combined with fentanyl 20 micro gram, and group 2 received 10 mg bupivacaine. Hypotension was recorded and was treated with intravenous ephedrine. Sensory blockade, intraoperative analgesia, motor blockade and side effects were assessed. RESULTS: No significant differences were observed in values for assessing hypotension, sensory blockade or intraoperative analgesia between the two groups. Also no significant differences were observed in intensity of the motor blockade and side effects between the two groups. However the duration of the motor blockade of group 1 was longer significantly than that of group 2. CONCLUSIONS: Small dose bupivacaine and fentanyl administered together intrathecally reduced duration of motor blockade and didn't augment of side effects and provided reliable anesthesia for surgery of knee or below knee simultaneously.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine* ; Ephedrine ; Fentanyl ; Humans ; Hypotension ; Knee

Purpose: We analyzed the choroidal thickness in the subfoveal area and area of retinal detachment (RD) in monocular primary rhegmatogenous retinal detachment (RRD) patients and compared the RD eye with the fellow eye. Methods: We retrospectively analyzed, optical coherence tomography data of both eyes at the first visit in patients who underwent surgery for monocular RRD from January 2013 to December 2016. Choroidal thickness was examined manually in the subfoveal and RD areas by two independent ophthalmologists; subjects without data from at least one of the two investigators were excluded. Results: Ninety-five subjects were included in this study. Of the 95 RD eyes, 61 (64.2%) and 44 (46.3%) eyes showed macula and fovea invasion, respectively. The subfoveal choroidal thickness was statistically significant in the RD eye compared with the fellow eye (244.7 ± 79.0 µm vs. 220.1 ± 78.9 µm; p < 0.001). Moreover, the choroidal thickness of the RD area in the RD eye was thicker compared with the non-detachment area and corresponding area in the fellow eye (273.8 ± 53.4 µm vs. 215.2 ± 44.0 µm and 233.3 ± 56.7 µm, respectively; p < 0.001). Conclusions In the primary RRD eye, the choroidal thickness in the detachment area was thicker than that of the fellow eye. Further studies are needed to investigate the mechanism of choroidal thickness change and its impact on RD.

Mesenchymal stem cells (MSCs) represent a population of adult stem cells residing in many tissues, mainly bone marrow, adipose tissue, and umbilical cord. Due to the safety and availability of standard procedures and protocols for isolation, culturing, and characterization of these cells, MSCs have emerged as one of the most promising sources for cell-based cardiac regenerative therapy. Once transplanted into a damaged heart, MSCs release paracrine factors that nurture the injured area, prevent further adverse cardiac remodeling, and mediate tissue repair along with vasculature. Numerous preclinical studies applying MSCs have provided significant benefits following myocardial infarction. Despite promising results from preclinical studies using animal models, MSCs are not up to the mark for human clinical trials. As a result, various approaches have been considered to promote the therapeutic potency of MSCs, such as genetic engineering, physical treatments, growth factor, and pharmacological agents. Each strategy has targeted one or multi-potentials of MSCs. In this review, we will describe diverse approaches that have been developed to promote the therapeutic potential of MSCs for cardiac regenerative therapy. Particularly, we will discuss major characteristics of individual strategy to enhance therapeutic efficacy of MSCs including scientific principles, advantages, limitations, and improving factors. This article also will briefly introduce recent novel approaches that MSCs enhanced therapeutic potentials of other cells for cardiac repair.

Purpose: We analyzed the choroidal thickness in the subfoveal area and area of retinal detachment (RD) in monocular primary rhegmatogenous retinal detachment (RRD) patients and compared the RD eye with the fellow eye. Methods: We retrospectively analyzed, optical coherence tomography data of both eyes at the first visit in patients who underwent surgery for monocular RRD from January 2013 to December 2016. Choroidal thickness was examined manually in the subfoveal and RD areas by two independent ophthalmologists; subjects without data from at least one of the two investigators were excluded. Results: Ninety-five subjects were included in this study. Of the 95 RD eyes, 61 (64.2%) and 44 (46.3%) eyes showed macula and fovea invasion, respectively. The subfoveal choroidal thickness was statistically significant in the RD eye compared with the fellow eye (244.7 ± 79.0 µm vs. 220.1 ± 78.9 µm; p < 0.001). Moreover, the choroidal thickness of the RD area in the RD eye was thicker compared with the non-detachment area and corresponding area in the fellow eye (273.8 ± 53.4 µm vs. 215.2 ± 44.0 µm and 233.3 ± 56.7 µm, respectively; p < 0.001). Conclusions In the primary RRD eye, the choroidal thickness in the detachment area was thicker than that of the fellow eye. Further studies are needed to investigate the mechanism of choroidal thickness change and its impact on RD.